Assessment of volume status and arterial stiffness in chronic kidney disease

Aim: There is limited information about arterial stiffness in chronic kidney disease (CKD) which is an independent risk factor for cardiovascular events. Pulse wave velocity (PWV), augmentation index (AIx) are using to determine arterial stiffness. We aimed to study PWV, AIx, volume status in patients with stage 3B-5 CKD and continuous ambulatory peritoneal dialysis (CAPD). Methods: Sixty-six stage 3B-5 CKD patients, 21 CAPD patients, 34 healthy controls were included. Pulse wave velocity, AIx, volume status was evaluated by Mobil-O-Graph®, and bioimpedance spectroscopy, respectively. Results: The Median PWV was 7.5?m/s in CKD, 6.2?m/s in CAPD, 5.9?m/s in healthy controls, and while PWV was found to have increased significantly in CKD patients (p?=?0.002), the Alx values were similar in all groups. The median extracellular fluid excess was higher in both the CKD and, CAPD patients when compared with healthy controls (1.26 and 1.21?L, respectively). Overhydration was more prevalent in CKD and CAPD patients (p?0.001). Age, central systolic blood pressure, body mass index, fat mass, overhydration, CKD, eGFR were the major determinants of PWV. Conclusion: Increased PWV was found in stage 3B-5 CKD patients. Overhydration may contribute this increment.     

Arterial stiffness correlated with cardiac remodelling in patients with chronic kidney disease

BACKGROUND: It is well known that both pressure and volume overloads contribute to left ventricular hypertrophy (LVH) and left ventricular dilatation in patients with chronic kidney disease (CKD). Few studies have evaluated the association between increased pulse wave velocity (PWV) and LVH in CKD patients not yet receiving dialysis. The purpose of this study was to assess the relationship between arterial stiffness and cardiac remodelling in patients with CKD, and to determine the independent factors associated with increased left ventricular mass index (LVMI) and left ventricular volume index (LVVI). METHODS: This cross-sectional study included 96 patients with CKD. Echocardiography and measurement of arterial stiffness by PWV were performed. Clinical and echocardiographic parameters were compared and analysed. RESULTS: Associated with the increase of PWV, there were significant trends for progressive increase in LVMI, LVH, LVVI, left ventricular dilatation and left atrium in CKD patients. Multivariate regression analysis revealed that decreased PWV, in addition to increased haemoglobin and the use of beta-blocker, was an independent determinant associated with decrease in LVMI and LVVI. CONCLUSION: Our study demonstrated the progressive structural remodelling of left ventricle and left atrium in CKD patients associated with increased severity of arterial stiffness. PWV was an important determinant of LVMI and LVVI in CKD patients.     

Association of brachial-ankle pulse wave velocity with cognitive impairment in peritoneal dialysis patients

BackgroundThe relationship between cognitive impairment (CI) and arterial stiffness in peritoneal dialysis (PD) patients has not been clearly clarified. The aim of this study was to examine the relationship between CI and arterial stiffness in PD patients.MethodsThis cross-sectional study enrolled PD patients who performed a vascular profiler test at a single PD center in China between January 2014 and June 2016. The cognitive function was evaluated using the Montreal cognitive assessment (MoCA). A noninvasive vascular screening device was used to assess arterial stiffness relevant indicators.ResultsA total of 643 PD patients with median age 45 (37–57.4) years and median duration of PD 27.8 (8.7–56.4) months were enrolled. The rate of CI was 49.9%. The mean brachial-ankle pulse wave velocity (baPWV) was 17.2 ± 5.6 m/s. Compared with normal cognitive function group, patients with CI had higher baPWV (18.6 ± 7.0 vs. 15.8 ± 3.2 m/s), systolic blood pressure (150.3 ± 21.5 vs. 144.2 ± 20.2 mmHg), and pulse pressure (59.7 ± 14.7 vs. 52.5 ± 11.6 mmHg), and lower ankle-brachial index (ABI, 1.12 ± 0.12 vs. 1.15 ± 0.09) (all p<.05). Compared with systolic blood pressure, pulse pressure, and ABI in receiver operating characteristic (ROC) analysis, baPWV had better performance in predicting CI (area under curve: 0.68, 95% confidence interval: 0.64–0.72). BaPWV was independently associated with MoCA score (B per SD, −0.42 [95% confidence interval, −0.71 to −0.12]; p = .006) and CI (OR per SD, 1.55 [95% confidence interval, 1.11–2.17]; p = .011) in PD patients after adjustment for confounders.ConclusionsHigher baPWV was independently associated with CI in PD patients.     

Comparing aortic stiffness in kidney transplant recipients, hemodialysis patients, and patients with chronic renal failure

Pan CR, Schmaderer C, Roos M, von Eynatten M, Sollinger D, Lutz J, Heemann U, Baumann M. Comparing aortic stiffness in kidney transplant recipients, hemodialysis patients, and patients with chronic renal failure.
Clin Transplant 2011: 25: E463–E468. © 2011 John Wiley & Sons A/S. Abstract: Background: The poor cardiovascular survival of patients with renal insufficiency is improved by transplantation. Carotid‐femoral pulse wave velocity (PWV) is able to predict independently overall and cardiovascular mortality. PWV is elevated in renal insufficiency. Consequently, PWV may change according to the improvement in renal function after kidney transplantation. Methods: In a cross‐sectional setting, PWV was determined in 40 renal transplant recipients (RTx) and compared to the PWV of 40 age‐ and gender‐matched patients with comparable renal insufficiency (CKD) and 40 age‐ and gender‐matched hemodialysis patients (HD). Results: RTx and CKD patients had comparable eGFR (RTx: 42.9 ± 18.4, CKD: 48.3 ± 29.1 mL/min/1.73 m²) and protein/creatinine ratio (RTx: median 172.5, 25th percentile 97.75, 75th percentile 344.5, CKD: median 183.272, 25th percentile 100.00, 75th percentile 470.00 mg/g creatinine). There was no significant difference in PWV between RTx 3–12 months post‐transplant and CKD or HD patients (RTx: 9.65 ± 1.57, CKD: 9.98 ± 3.91, HD: 10.27 ± 2.89 m/s; n = 20 pairs). Similarly, PWV in transplant patients >12‐month post‐transplant was similar to that of CKD and HD patients (RTx: 9.71 ± 2.23, CKD: 9.36 ± 2.74, HD: 9.84 ± 3.41 m/s; n = 20 pairs). Discussion: We could not detect significant differences in PWV comparing RTx with age‐ and gender‐matched CKD patients.     

Relationship between serum uric acid levels with chronic kidney disease in a Southeast Asian population

Aim: Elevated serum uric level has been suggested as a risk factor for chronic kidney disease (CKD). The relationship between serum uric acid level, and CKD in a Southeast Asian population was examined. Methods: In a cross‐sectional study, authors surveyed 5618 subjects, but 5546 participants were included. The glomerular filtration rate (GFR) values were calculated by the Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as a GFR of less than 60 mL/min per 1.73 m². Multivariate binary logistic regression was used to determine the association between serum uric acid level and CKD. Results: The prevalence of CKD in serum uric acid quartiles: first quartile, 5.3 mg/dL or less; second quartile, 5.4–6.4 mg/dL; third quartile, 6.5–7.6 mg/dL; and fourth quartile, 7.7 mg/dL or more were 1.8%, 3.6%, 5.5% and 11.9%, respectively (P < 0.001). The mean values of estimated GFR in participants with CKD and without CKD were 53.44 ± 7.72 and 81.26 ± 12.48 mL/min per 1.73 m² respectively. In the entire participants, there were 6.76% with hypertension and 2.64% with diabetes as a comorbid disease. Compared with serum uric acid first quartile, the multivariate‐adjusted odds for CKD of the fourth, third and second quartile were 10.94 (95% confidence interval (CI), 6.62–16.08), 4.17 (95% CI, 2.51–6.92) and 2.38 (95% CI, 1.43–3.95), respectively. Conclusion: High serum uric acid level was independently associated with increased prevalence of CKD in the Southeast Asian population. Detection and treatment of hyperuricaemia should be attended as a strategy to prevent CKD.     

The effects of whole body vibration on pulse wave velocity in men with chronic spinal cord injury

Objective: A pilot study to evaluate the therapeutic potential of 40 weeks of passive standing with whole body vibration (PS-WBV) on central and peripheral arterial stiffness among men with chronic spinal cord injury (SCI).

Methods: Consenting participants were pre-screened to ensure safe participation. Fifteen individuals with chronic SCI were enrolled to participate in PS-WBV sessions three times per week for 40 weeks on a modified WAVE platform custom-fitted with an EASYStand 5000. Knee angle was set at 160°, and vibration parameters were 45Hz frequency and 0.7mm displacement. Each 45-minute session of PS-WBV training was intermittent (60 seconds on and 120 seconds off). Aortic and leg pulse wave velocity (PWV) was measured at baseline, mid-point (20 weeks) and exit (40 weeks).

Results: Nine males (age 41±11 years, American Spinal Injury Association Impairment Scale A-D, neurological level of injury T4-T10, years post-injury 12±8 years) completed the intervention. Aortic PWV was collected on n=7 at exit, and leg PWV was collected on n=6 at exit. No changes over time were found for either aortic PWV (P?=?0.46) or leg PWV (P?=?0.54). One possible study-related serious adverse event occurred during study intervention: the development of a grade III pressure sore on the right proximal anterior shin (n=1).

Conclusion: Forty weeks of PS-WBV in adults with SCI did not result in an observable change in arterial stiffness.     

老年慢性肾脏病早期患者疾病相关知识与自我管理能力的相关性

目的了解老年慢性肾脏病早期(1～3期)患者自我管理能力及疾病相关知识掌握现状,分析疾病相关知识对自我管理能力的影响,为针对性干预提供依据。方法采用疾病相关知识问卷和慢性肾脏病早期患者自我管理量表,对213例老年慢性肾脏病早期患者进行调查。结果 213例患者自我管理能力得分为(76.85±19.21)分,处于中等水平;疾病相关知识得分为(20.56±10.82)分,处于低等水平;自我管理能力及各维度与疾病相关知识呈显著正相关(均P0.01);疾病相关知识能解释自我管理能力35.7%的变异,对自我管理能力有正向预测作用(P0.01)。结论老年慢性肾脏病早期患者的疾病相关知识和自我管理能力均有待提高,应加强对该类患者的健康宣教,提高其疾病相关知识水平及自我管理能力,达到延缓疾病进展和增进健康的目的。     

正常人及肾脏病非透析患者硫酸吲哚酚研究

目的 了解我国正常人及慢性肾脏病非透析患者血及尿中硫酸吲哚酚状况.方法 采用液相色谱-质谱联用分析法对120名健康志愿者、334例不同肾功能水平的慢性肾脏病患者血及尿中硫酸吲哚酚等指标进行测定.结果 正常人血及尿硫酸吲哚酚浓度范围分别为(0.59±0.26)mg/L、(43.2±15.9)mg/L;正常人群与66例Ⅰ期肾病患者血及尿硫酸吲哚酚水平比较差异无统计学意义(t=0,P=1;t=1.17,P=0.24);随着肾功能下降血及尿硫酸吲哚酚水平出现明显差异;血硫酸吲哚酚水平与肾小球滤过率、尿硫酸吲哚酚浓度均呈负相关(r分别=-0.58、-0.53,P均＜0.05).结论 正常人群不同年龄组血及尿内硫酸吲哚酚水平比较差异无统计学意义,但随着肾功能的下降而出现血硫酸吲哚酚浓度上升、尿中排出硫酸吲哚酚浓度下降.     

慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性

目的 探讨慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性.方法 选取慢性肾脏病(CKD l～5期)患者300例,根据血25(OH)D3浓度分为维生素D缺乏组[25 (OH)D3＜20 μg/L]和维生素D非缺乏组[25(OH)D3≥20 μg/L].采集临床资料数据,测定动脉僵硬度指标肱踝脉搏波传导速度(baPWV).对血25(OH)D3水平与baPWV间的关系进行单因素相关分析及多元线性回归分析. 结果 维生素D缺乏组188例(62.7％),维生素D非缺乏组112例(37.3％).全部CKD患者25(OH)D3平均浓度为(17.62±8.54) μg/L,维生素D缺乏组和非缺乏组分别为(12.38±4.55) μg/L与(26.44±6.05) μg/L(P＜0.01).维生素D缺乏组baPWV值高于非缺乏组[(1 827.34±429.11) cm/s比(1 555.31±353.14) cm/s,P＜0.01].单因素相关分析显示全体CKD患者(r=-0.38,P＜0.01)以及CKD 2～5期患者[r=-0.30,P＜0.05;r=-0.26,P＜0.05;r=-0.46,P＜0.01;r=-0.57,P＜0.01]血25(OH)D3浓度与baPWV均呈负相关.多元线性回归分析显示血25 (OH)D3浓度下降与baPWV的增加独立相关(模型1:β=-0.18,P＜0.01;模型2:β=-0.17,P=0.01),回归模型1与模型2均可解释baPWV变化的50％.结论 CKD患者普遍存在维生素D缺乏,维生素D缺乏与动脉僵硬度增加相关.维生素D替代治疗可能影响CKD患者的心血管预后,但有待未来研究的进一步明确.     

Reproducibility of pulse-wave analysis and pulse-wave velocity determination in chronic kidney disease.

BACKGROUND: Indices of central arterial stiffness, derived by use of applanation tonometry, have shown to be strong independent predictors of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). The objective of this study was to evaluate the intra- and inter-observer and day-to-day reproducibility of pulse-wave analysis (PWA) and pulse-wave velocity (PWV) in pre-dialysis patients with CKD stages 3-5 using applanation tonometry with the SphygmoCor software and hardware. METHODS: Double recordings of the radial pressure waveform and the aortic and brachial PWV were performed under standardized conditions in 19 CKD patients with a mean GFR 25.3 ml/min/1.73 m(2) (range 9.9-42.2) by two trained observers and repeated by one of the observers within a week. RESULTS: The mean inter-observer and day-to-day differences (+/-2 SD) for the augmentation index (AIx) were 0.9 +/- 15.8% and 2.6 +/- 11.2%, for subendocardial viability ratio (SEVR) -0.9 +/- 15.5% and -0.4 +/- 24.7%, for aortic pulse pressure (PP) 1.4 +/- 13.3 mmHg and 0.3 +/- 20.9 mmHg and for aortic PWV 0.3 +/- 3.2 m/s and -0.7 +/- 1.9 m/s, respectively. Intra-observer differences were calculated for each of three sets of double measurements and showed good reproducibility as well. Calculations on sample size needed in a clinical trial showed a limited number of patients needed in a clinical study over time. CONCLUSIONS: PWA and PWV based on applanation tonometry using the SphygmoCor software and hardware are highly reproducible in pre-dialysis patients with CKD with the day-to-day variation being in accordance with the intra- and inter-observer variation. Thus, applanation tonometry using the SphygmoCor system is a simple, non-invasive method to assess central haemodynamics in clinical trials in patients with pre-dialysis CKD with only a limited number of patients needed to detect significant differences.     

Comparison of serum paraoxonase and arylesterase activities between iron deficiency anemia patients and chronic kidney disease patients with anemia

Objective: Altered paraoxonase (PON) and arylesterase (ARE) activities have been shown in anemic chronic kidney disease (CKD) patients and in iron deficiency anemia (IDA) patients. Whether accompanying anemia alone is responsible for this diminished PON and ARE activities in CKD patients or an additive factor for this is not well studied. Therefore, we tried to clarify this issue here. Methods: A total of 82 subjects that consisted of 19 patients with IDA (group 1), 23 anemic CKD patients (group 2), and 40 age and sex matched healthy subjects (group 3) were enrolled. Carotid intima media thickness (CIMT), serum total thiol (–SH), PON, and ARE activities of the participants were analyzed. Results: Group 2 patients had significantly lowest serum levels of Total –SH, PON and ARE. Further comparison showed that total –SH, PON and ARE levels were lower in group 1 than group 3 (p?=?0.0001 in both). Regarding comparison of group 1 and 2, only serum ARE levels were significantly lower in group 2 (p?=?0.001). PON activity was not different between group 1 and group 2 whereas ARE activity was lower in group 2 than groups 1 and 3. In addition, correlation analysis showed that CIMT was negatively correlated with PON and ARE. Conclusions: This markedly decreased ARE activity in CKD patients, which could not be explained by the anemia alone, may have a role in the pathogenesis of increased atherosclerosis in such patients. Still further studies are needed to certain this.     

Better recovery of kidney function in patients with de novo chronic kidney disease after partial nephrectomy compared with those with pre‐existing chronic kidney disease

We compared kidney functional recovery between patients with pre‐existing chronic kidney disease, those with de novo chronic kidney disease and those with normal kidney function, after partial nephrectomy. A total of 311 patients who underwent partial nephrectomy at Tokyo Women's Medical University Hospital, Tokyo, Japan, between January 2004 and July 2011 with sufficient kidney functional data participated in the study. Patients with pre‐existing chronic kidney disease (group1: 78 patients) were defined as those with estimated glomerular filtration rate under 60 mL/min/m² before partial nephrectomy. Patients with de novo chronic kidney disease (group 2: 49) were defined as those with estimated glomerular filtration rate over 60 mL/min/m² before surgery and who developed estimated glomerular filtration rate under 60 mL/min/m² 3 months after partial nephrectomy. Normal patients (group 3: 184) were defined as those with estimated glomerular filtration rate over 60 mL/min/m² both before and after partial nephrectomy. Group 1 was associated with older age and higher comorbidity, including hypertension and diabetes mellitus, compared with other groups. R.E.N.A.L. score was not significantly different between the groups. Although the percent change of estimated glomerular filtration rate between the preoperative period and 3 months after partial nephrectomy in group 2 was significantly decreased compared with that in other groups (group 1: ?6.8%, group 2: ?18%, group 3: ?7.3%), the renal functional recovery between 3 and 12 months after partial nephrectomy in group 2 was better than that in other groups (group 1: ?0.5%, group 2: 5.6%, group 3: ?0.4%). Patients with de novo chronic kidney disease had better kidney functional recovery than the other two groups, which might suggest that they were surgically assaulted and developed chronic kidney disease in the early postoperative period, and were essentially different from those with pre‐existing chronic kidney disease.     

慢性肾脏病患者动脉弹性功能相关因素分析

目的：探讨慢性肾脏病（CKD）患者动脉弹性功能指标变化规律,并对其相关因素进行分析,为临床预防和治疗慢性肾脏病患者的心血管并发症提供理论依据。方法：选择92例CKD患者为研究对象,采用标准袖带水银血压计测量非动静脉内瘘侧上臂坐位血压,动脉脉搏波分析仪（SphygmoCor px）检测动脉弹性指数脉搏波速度（PWV）和压力反射波增强指数（AIx）,临床检验测定患者各项指标,提取临床病史资料,对患者AIx及PWV与临床各项检查检验指标分别进行单因素相关分析和多元逐步回归分析。结果：（1）Pearson相关分析显示：CKD患者AIx与PWV、年龄、收缩压和舒张压呈正相关,而与身高、体重、红细胞压积、血红蛋白、胆固醇（TC）和肾小球滤过率（GFR）呈负相关;PWV与AIx、年龄、收缩压和病程（月）均呈正相关（P〈0.05）。（2）Spearman秩相关分析显示：AIx与心血管病病史及降压药种数呈正相关;PWV与心血管病病史、糖尿病史和降压药种数呈正相关（P〈0.05）。（3）多元逐步回归分析显示：年龄、心率、收缩压和心血管病史、身高和体重是影响CKD患者AIx的独立决定因素;而年龄、收缩压和糖尿病是影响患者PWV的独立决定因素（P〈0.05）。结论：（1）CKD患者的年龄、收缩压和心血管病史、身高和体重是CKD患者AIx的重要影响因素;而年龄、收缩压和糖尿病是影响患者PWV的独立决定因素。（2）GFR与动脉弹性功能有一定的关联性,传统的致血管硬化因素仍是主要因素。     

Effect of sildenafil on arterial stiffness, as assessed by pulse wave velocity, in patients with erectile dysfunction

BACKGROUND: The problems of patients with erectile dysfunction have been recognized, leading to the emergence of sildenafil, which has led to successful treatment in many cases. The purpose of this study is to examine the effect of sildenafil on the pulse wave velocity of patients with erectile dysfunction. METHODS: Fifteen patients with erectile dysfunction were enrolled for this study. The brachial/ankle pulse wave velocity was determined before dosing and at 30, 60, 120, and 180 min after dosing with 25 or 50 mg of sildenafil citrate. Concurrently, the changes in blood pressure, heart rate, and brachial/ankle pulse wave velocity were measured. For the consideration of revised brachial/ankle pulse wave velocity by blood pressure, the systolic blood pressure-derived brachial/ankle pulse wave was also investigated, and we classified and examined those results with and without risk factors for arteriosclerosis. RESULTS: The systolic blood pressure decreased significantly at 60 min after dosing compared with the placebo control. The heart rate decreased at 120 min after dosing compared with the placebo control but that decrease was not significant. The brachial/ankle pulse wave velocity transiently decreased at 30 or 60 min after dosing compared with the placebo control, but the decrease was not significant; however, the systolic blood pressure-derived brachial/ankle pulse wave velocity decreased significantly. In those patients with risk factors for arteriosclerosis, the pulse wave velocity decreased significantly. CONCLUSION: In patients with erectile dysfunction who were administered sildenafil, the pulse wave velocity, along with blood pressure, tended to decrease transiently after dosing. There is a possibility that sildenafil affects the improvement of erectile dysfunction via the decrease of pulse wave velocity, especially in patients with risk factors for arteriosclerosis.     

Association between chronic kidney disease and small residual urine volumes in patients with benign prostatic hyperplasia

Aim: It has been well described that large residual urine volumes (≥300 mL) affect renal function in advanced benign prostatic hyperplasia (BPH). However, it is not clear whether small residual urine volumes (<100 mL) are related to renal function. The present study was performed to examine the association between chronic kidney disease (CKD) and the post‐void residual urine volume (PVR) in BPH patients. Methods: A cross‐sectional study was performed in 160 consecutive BPH patients with PVR of less than 100 mL. We first determined the stage of CKD and compared the PVR in subjects with/without CKD. Next, we divided the subjects into three groups according to the extent of PVR (PVR < 12 mL, 12 mL ≤ PVR < 50 mL, 50 mL ≤ PVR < 100 mL) and compared the estimated glomerular filtration rate (eGFR) among these groups. Moreover, risk factors associated with CKD, including the presence of post‐void residual urine, were explored by multiple logistic regression analysis. Results: The PVR of the patients with CKD was significantly greater than that of the patients without CKD. The group with the normal PVR (group PVR < 12 mL) had a significantly higher eGFR compared with the other two groups. Multivariate analysis demonstrated that the presence of post‐void residual urine (PVR ≥12 mL) was a significant and independent risk factor associated with the presence of CKD. Conclusion: In BPH patients, the PVR of the patients with CKD was significantly greater than that of the patients without CKD and the presence of post‐void residual urine (PVR ≥12 mL) was independently associated with CKD, indicating a close association between CKD and small residual urine volumes.     

Association between visit-to-visit clinic blood pressure variability and home blood pressure variability in patients with chronic kidney disease

Abstract

Although both clinic blood pressure (BP) variability and home BP variability are associated with the risk of cardiovascular disease, the relationship between both BP variabilities remain unclear. We evaluated the association between visit-to-visit variability of clinic BP (VVV) and day-by-day home BP variability (HBPV) in patients with chronic kidney disease (CKD). We recruited 143 CKD patients in whom we performed HBP measurements every morning and evening over seven consecutive days. We obtained clinic BP data during 9.6?±?1.0 consecutive visits within 24 months. The associations between the variables of VVV and HPBV were examined. The CV values of clinic systolic BP (CSBP) was significantly correlated with the mean values of morning systolic BP (MSBP) and those of evening systolic BP (ESBP) (r?=?0.23, 0.20; p?=?0.007, 0.02, respectively). The CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP (r?=?0.19, 0.31; p?=?0.02, <0.001, respectively). On the multivariate regression analysis, the CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP [standardized regression coefficient (β)?=?0.19, 0.34; p?=?0.03, <0.001, respectively]. In conclusion, VVV showed a weak but significant association with HBPV, especially the CV values of ESBP in CKD patients. Further studies are necessary to clarify whether these different BPV elements will be alternative marker of BPV.